Assessment of an alternative meropenem dosing strategy compared with imipenem-cilastatin or traditional meropenem dosing after cefepime failure or intolerance in adults with neutropenic fever.

Abstract

STUDY OBJECTIVE:

To compare clinical outcomes of patients receiving an alternative dosage of meropenem with those of patients receiving imipenem-cilastatin or the traditional dosage of meropenem after failure of or intolerance to cefepime for treatment of febrile neutropenia.

DESIGN:

Retrospective, single-center cohort study.

SETTING:

1250-bed urban academic medical center.

PATIENTS:

One hundred twenty-seven adults with neutropenic fever who received either imipenem-cilastatin or meropenem; imipenem-cilastatin was the preferred carbapenem until September 1, 2006, after which meropenem became the formulary carbapenem.

MEASUREMENTS AND MAIN RESULTS:

Of the 127 patients, 40 received imipenem-cilastatin 500 mg every 6 hours between September 1, 2005, and August 31, 2006; 87 patients received meropenem between September 1, 2006, and August 31, 2007: 29 received a traditional dosage of meropenem 1 g every 8 hours, and 58 received an alternative dosage of meropenem 500 mg every 6 hours. Primary outcomes of time to defervescence (median 3 vs 2 vs 3 days), need for additional antibiotics (20% vs 17% vs 14%), and time to receipt of additional antibiotics (median 5 vs 2 vs 1 days) were not significantly different among the imipenem-cilastatin, traditionally dosed meropenem, and alternatively dosed meropenem groups, respectively. In addition, significant differences in secondary outcomes, which were treatment duration (median 10 vs 8 vs 8 days), seizure rate (0% vs 0% vs 0%), in-hospital mortality (5% vs 7% vs 7%), and 30-day mortality (13% vs 7% vs 14%), were not identified among the three groups, respectively.

CONCLUSION:

The alternative meropenem dosage of 500 mg every 6 hours yielded similar patient outcomes, including time to defervescence, need for additional antibiotics, duration of therapy, and mortality, when compared with the traditional meropenem dosage and imipenem-cilastatin in adults with febrile neutropenia. In addition, no adverse effects on clinical outcomes were observed with the alternative dosage of meropenem.

• Authors: Heather M Arnold, Peggy S McKinnon, Kristan M Augustin, Lindsay M Hladnik, Ed Casabar, Richard M Reichley, Erik R Dubberke, Peter Westervelt, David J Ritchie
• Journal: Pharmacotherapy (Pharmacotherapy) Vol. 29 Issue 8 Pg. 914-23 (Aug 2009) ISSN: 1875-9114 [Electronic] United States
• PMID: 19637944 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Anti-Bacterial Agents
• Cephalosporins
• Drug Combinations
• Thienamycins
• Cilastatin
• Imipenem
• Cefepime
• Cilastatin, Imipenem Drug Combination
• Meropenem

Topics

• Adult
• Anti-Bacterial Agents (administration & dosage, adverse effects)
• Cefepime
• Cephalosporins (adverse effects, therapeutic use)
• Cilastatin (administration & dosage)
• Cilastatin, Imipenem Drug Combination
• Cohort Studies
• Dose-Response Relationship, Drug
• Drug Combinations
• Female
• Fever (complications, drug therapy, mortality)
• Hospital Mortality
• Humans
• Imipenem (administration & dosage)
• Male
• Meropenem
• Middle Aged
• Neutropenia (complications, drug therapy, mortality)
• Retreatment
• Seizures (drug therapy)
• Thienamycins (administration & dosage)
• Time Factors